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FIELD TRIP REQUEST FORM

Untitled Document
Name:
Street Address:
City: , State:    Zip Code:
Phone # (home)
Phone # (cell):
Email address:
   
School/Organization:
School Address:
City: , State:    Zip Code:
Phone #(school):
School Fax #:
   
   
  Arrival and Departure Dates Requested (top 3 choices):


   
  Arrival Time to LUMCON:
  Departure Time from LUMCON:
   
  Number of Participants (adults and children):
Until further notice, Marine Education cannot accept requests for more than 25 people total. When staff and facilities are adequate, the limit will be lifted.
   
  Age/grade level of participants:
   
  Activities Preference:
   
  Course requirements:
(GLEs, benchmarks, standards) or other educational goals you would like to accomplish
   
       
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